MEDICARE: MIAMI VALLEY PODIATRY ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	36002504	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164755096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIAMI VALLEY PODIATRY ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	1435 ROMBACH AVE
Second Line	:	UNIT 6
City	:	WILMINGTON
State	:	OH
Zip	:	45177-1991
Country	:	US
Telephone Number	:	937-382-2347
Fax Number	:

Provider Business Practice Location Address
First Line	:	1435 ROMBACH AVE
Second Line	:	UNIT 6
City	:	WILMINGTON
State	:	OH
Zip	:	45177-1991
Country	:	US
Telephone Number	:	937-382-2347
Fax Number	:

Authorized Official
Title or Position	:	DPM
Name	:	JOHN STEVENSON
Credential	:
Telephone Number	:	937-382-2347

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	05/12/2010

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Directions to “MIAMI VALLEY PODIATRY ASSOCIATES LLC ” Practice Location

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